A new review, published in The Lancet as part of its Every Newborn Series, provides a sobering assessment of global progress towards implementing and evaluating effective interventions to reduce newborn deaths and stillbirths.

The review, led by Dr Gary Darmstadt, atthe Bill & Melinda Gates Foundation, USA,shows that although there have been considerable advancesin improving health care for newborn babies in the last two decades, further progress has been hindered by disappointing levels of investment, poor coordination globally and with countries, and inadequate translation of attention into effective national policies, health care programmes, and evaluation and monitoring of newborn health.
The authors find that the visibility of newborn health within global health policy making has greatly
improved in the last decade, thanks to determined advocacy by parent groups, technical experts, and other champions. As a result, effective, evidence-based policies to improve newborn health are now being implemented in many countries, but more needs to be done to scale up interventions, especially for the hardest to reach populations.

The successes and challenges to improving newborn heath over the last decade have been accompanied by disappointing levels of investment in newborn health, say the authors. Despite the fact that newborn deaths account for nearly half of all deaths in children under five, just 4% of investment in child health is thought to be directed towards newborn babies, and far greater investment will be needed if child mortality is to improve in the coming decades.

Moreover, the 2.6 million stillbirths thought to occur every year remain invisible on the global health agenda, and progress in improvement of newborn survival and reduction of stillbirths lags behind that of maternal mortality and deaths for children aged 1-59 months.

In the absence of coordinated leadership - both nationally and globally - for newborn health,
implementation of programmes has suffered, and evaluation and data collection remain inadequate.

These problems are compounded by the fact that in many of the countries with the highest burden of newborn deaths, parents - especially women - do not have a powerful voice, and no group of health professionals has overall responsibility for newborn health.

According to Dr Darmstadt, "While the last decade has seen remarkable progress in some areas of newborn health, it is clear that much more remains to be done. Despite the evidence showing that there are feasible and affordable solutionsto this problem - which include political prioritisation,
increased investment, and concerted country action - poor global leadership, and inadequate
coordination, evaluation, and accountability, are hindering progress.""Improvement of child survival will depend on greater investment in newborn survival, and continued efforts to implement effective, evidence-based policies for newborn health in every country. The question we now need to answer is: who will step up during the next decade to ensure decision making in countries leads to reductions in stillbirth and improvements in newborn health? The Every Newborn Action Plan [1] provides the best opportunity we have had yet to close gaps between burden and
investment and between policy and action."

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